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General NPI Number Information
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NPI Number | 1043408941
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Entity Type | Organization
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Legal Business Name | CASTORIA SEYMORE, JR. MD A PROFESSIONAL CORPERATION
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Dates
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Enumeration Date | 10/05/2007
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Last Update Date | 10/05/2007
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Provider Practice Location Address
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Address Line | 4644 LINCOLN BLVD 424
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6313
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Country | US
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Telephone | 131-048-2690
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Fax | 131-048-2695
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Provider Business Mailing Address
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Address Line | 4644 LINCOLN BLVD 424
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6313
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Country | US
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Telephone | 131-048-2690
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Fax | 131-048-2695
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | MISS CASTORIA SEYMORE JR.
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Credential | MD
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Telephone | 13104826906
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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